Wisdom from Wisot Wednesdays, Round Nine!

Welcome to the Happy Holidays edition of WFWW, where fertility expert Dr. Arthur Wisot answers your very personal questions. It's kind of a silent night: just two questions. And of course, the disclaimer: "My answers to questions on this blog do not constitute medical advice, but are merely meant to create an educational forum for consumers. It is always best to discuss these issues with your health care provider.

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The good doctor's answers are below, in bold

Question #1: I'm 30, my husband is 34. We've been trying for a year, using ovulation predictor kits (OPKs) for the last 5 or 6 months. Through my OBGYN, we've done sperm analysis (SA) for my husband, and thyroid, progesterone, prolactin, ultrasound, and HSG for me. Everything was normal. When I called to ask about what to do next after the HSG, she said that since I was so "persistent" she'd schedule me for a sonohysterogram. I just found out how much it will cost, and I'm wondering if I really need that. My insurance doesn't cover any of this. The only other thing, which I've told the OBGYN about, is that for many/most of my cycles since stopping birth control, I've had about two days of spotting, barely enough to notice, right before getting my period. Otherwise, my period is mostly regular (only off by one or two days at the most). What would you suggest to me? Should I do more tests, wait a while longer, or try something else?

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I think your being "persistent" is a virtue and her saying that tells me that she does not take your concerns seriously. Having tried for a year, six months with at least pretty good timing from the OPKs, and normal tests are indications that you should be pregnant by now and so it is time to move along. At this point I would look at a postcoital test to make sure the sperm can get through the cervix. I would also see how many days there are between your ovulation and that spotting to make sure you do not have a short luteal phase despite a normal progesterone. She may have suggested the sonohysterogram (looking at the uterine cavity with saline in the uterus) to make sure that you don't have a polyp causing the spotting. But the HSG should have picked that up as it looks at the same thing. With her attitude you might want to have a consultation with a reproductive endocrinologist (RE) as you get deeper into the workup and treatment.

Question #2: Hi, Dr. Wisot. My husband and I recently met with an RE, who said that our only hope of conceiving would be through IVF w/ ICSI. DH's count was 1 Million, Motility 4%, and Morph 10%. I realize how bad these numbers are but is there any other option for us? Maybe a way to improve his counts? The RE is having bloodwork done to check for genetic issues for indications as to why his counts are so bad. (BTW My test results were fine.) Thanks in advance....

The RE is probably correct. But it would not hurt to see a urologist who specializes in infertility to see if there are any problems which are correctable before you dive into IVF. But depending on your age you might not want to spend a lot of time going down that road. It's good that the RE is checking out genetic issues with probably a karyotype and Y-chromosome deletion tests. I would guess you will need IVF with ICSI.